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AHCPR To Demonstrate Use of Computerized Decision-Support Software in Clinical Practice

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Press Release Date: December 18, 1996

New research efforts announced today by the Agency for Health Care Policy and Research (AHCPR) are designed to explore the benefits of using computerized decision-support systems in everyday clinical practice.

"These projects will take medical decisionmaking computer software programs out of the laboratory and put them into primary care networks," said Clifton R. Gaus, Sc.D., AHCPR administrator. "The studies are designed to ascertain whether everyday use of these systems can improve health care quality, efficiency and effectiveness at a reduced cost." Dr. Gaus said that each project will focus on a clinical area where the appropriate diagnosis and management of illnesses is less than ideal.

This research is a component of AHCPR's participation, as one of 12 member agencies, in the High Performance Computing and Communications Program of the United States (HPCC) and in the National Information Infrastructure (NII), an initiative of President Clinton and Vice President Gore. HPCC and NII promote increased speed and capacity of computers and electronic networks, as well as make the transmission and storage of data more secure.

AHCPR aims to link HPCC technology to community health needs, specifically in the areas of computer-based patient records, computerized decision-support systems and telemedicine. With its research in these areas, AHCPR is evaluating promising technologies for measuring outcomes, access and cost impacts of health care, and for delivering improved quality of care.

"As part of the HPCC and NII efforts, the new projects will build upon AHCPR's research experience with computer-based patient record systems and telemedicine," said J. Michael Fitzmaurice, Ph.D., director of AHCPR's Center for Information Technology.

The studies use networks such as the Internet as vehicles for extending the use of these computer systems beyond academic medical centers and into the offices of primary care physicians. "The result of this research should lead to increased awareness of computer technology that will ultimately enhance information sharing among health care providers and practitioners," said Dr. Fitzmaurice.

AHCPR will spend a total of $4.55 million to support the studies over a three-year period.

The studies are:

  • Computerized Decision Support for Post-Transplant Care. (Grant No.: HS09407) Principal investigator: Keith M. Sullivan, M.D., Fred Hutchinson Cancer Research Center, Seattle, Wash. 1996-1999. Total estimated funding: $1.51 million.

    Will look at improving primary care physicians' abilities to manage post-discharge bone marrow transplantation patients by developing, implementing and evaluating a World Wide Web-based computerized decision-support system. The intent is to facilitate information exchange and guide interactions among physicians in different locations and centrally located experts in bone marrow transplantation.

  • Family Linkages Supporting Hyperbilirubin Guidelines. (Grant No.: HS09390) Principal investigator: Charles J. Homer, M.D., Children's Hospital, Boston, Mass. 1996-1999. Total estimated funding: $726,589.

    Will address the problem of hyperbilirubinemia in infants by developing and implementing a computer-based decision-support system. This system will help providers identify and treat infants at risk for developing significant medical problems associated with hyperbilirubinemia by providing better access to patient records and guidelines. Although most infants develop transient, unconjugated hyperbilirubinemia between the second and fifth day of life, the elevation of bilirubin is usually self-limited since liver enzyme activity normally picks up within a few days. The issue is how to detect and treat cases that are not so benign.

  • Depression Care Using Computerized Decision Support. (Grant No.: HS09421) Principal investigator: Bruce L. Rollman, M.D., University of Pittsburgh, Pittsburgh, Pa. 1996-1999. Total estimated funding: $644,409.

    Will develop and implement a computerized decision-support system that prompts primary care physicians to implement treatment recommendations based upon the AHCPR-sponsored practice guideline on depression in primary care. Following this, the researchers will conduct a randomized clinical trial to examine the clinical outcomes and costs of providing care this way, and will evaluate the effects on physicians' practices, knowledge and attitudes of disseminating the depression guideline by computer.

  • Evaluating Computer Decision Support for Preventive Care. (Grant No.: HS09507) Principal investigator: Stephen M. Downs, M.D., University of North Carolina, Chapel Hill, N.C. 1996-1999. Total estimated funding: $878,855.

    Will expand and modify for everyday use in pediatric office practices an existing guideline-based computerized decision service for childhood preventive services. The study will evaluate the effects of the system on process of care and outcomes of patients in private pediatric practice.

  • Interactive, Guideline-Based Decision Support on the Web. (Grant No.: HS09436) Principal investigator: David F. Lobach, M.D., Ph.D., Duke University Medical Center, Durham, N.C. 1996-1999. Total estimated funding: $785,343.

    Will study the increased use of guideline recommendations by automating clinicians' access to a decision-support system that makes relevant guidelines available at the point of care through an interface with electronic medical record systems. This study will create a clinical decision-support system that uses a World Wide Web-based guideline server. The server is directly accessible from electronic medical records systems and protects patient confidentiality.

In addition, AHCPR has funded one other study on computerized decision support through an interagency agreement with the National Library of Medicine. The study, "Computerized Decision-Support Deployment in Diverse Clinical Settings," will be led by Michael G. Kahn, M.D., Ph.D., Barnes Jewish Hospital, St. Louis, Mo. In this study, researchers will implement and evaluate two computerized drug monitoring systems—DoseChecker and ADE Monitor—and design and implement a drug alert notification subsystem in different clinical settings within the Washington University and Barnes Jewish Hospital health system. The alert notification subsystem will be evaluated for differences in expert system performance, physician acceptance and clinical impact.

The Agency for Health Care Policy and Research, a part of the Department of Health and Human Services, is the lead agency charged with supporting research designed to improve the quality of health care, reduce its cost and enhance access to essential services. AHCPR's broad programs of research and technology assessment bring practical, science-based information to medical practitioners, and to consumers and other health care purchasers.

For additional information, contact AHCPR Public Affairs: Howard Holland, (301) 427-1857; Salina Prasad, (301) 427-1864.

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